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Flail chest--pathophysiology, treatment and prognosis
Annales Chirurgiae Et Gynaecologiae
|January 1, 1983
Summary
Severe rib fractures and lung contusions causing respiratory issues require intensive care. Early mechanical ventilation with IMV and PEEP significantly reduces treatment duration and the need for tracheostomy.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Pulmonary Medicine
Background:
- Multiple injuries frequently involve unstable serial rib fractures and pulmonary contusions.
- These injuries often lead to severe respiratory insufficiency.
- Prompt intensive care unit (ICU) management is crucial.
Purpose of the Study:
- To evaluate the efficacy of early mechanical ventilation with specific settings in managing respiratory insufficiency due to rib fractures.
- To assess the impact of this treatment strategy on ventilation duration, tracheostomy rates, and oxygen requirements.
Main Methods:
- Patients with unstable serial rib fractures and pulmonary contusions were treated from the outset in the ICU.
- Mechanical ventilation was initiated using intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP).
Main Results:
- The duration of respirator treatment was reduced by approximately half compared to previous methods.
- Tracheostomy was seldom required.
- Lower oxygen concentrations (around 35%) were sufficient, reducing the risk of oxygen toxicity.
Conclusions:
- Early initiation of mechanical ventilation with IMV and PEEP is an effective strategy for managing respiratory insufficiency in patients with severe rib fractures.
- This approach significantly shortens ventilation time and decreases the need for tracheostomy.
- The prognosis is negatively impacted by concomitant head injuries or severe abdominal trauma.